Homebirth midwives treat deadly coronavirus as a marketing opportunity

Portrait of a cheerful girl covering her eye with dollar bills and showing thumb up isolated on a white background

The deadly coronavirus pandemic is a disaster for individuals, a disaster for public health and a disaster for the economy.

But one group is positively excited about the calamity: homebirth midwives.

Why? They view the tragedy as an awesome marketing opportunity.

One group is positively excited by the coronavirus calamity.

The Midwives Alliance of North America is all over it. Their latest blog post is The Impact of Coronavirus on Community Birth. MANA Vice President Sarita Bennett is positively gleeful about the deaths and economic havoc:

While thinking I’d much rather spend my time planning how to spread community midwifery, I realized how the two – virus and midwifery – may impact each other… It only makes sense for out of hospital birth to become the safer choice for the majority of people in a crisis like this.(emphasis in original)

To my knowledge, coronavirus has spread around the world so quickly because it is COMMUNITY acquired, NOT hospital acquired. Therefore, people face the greatest threat of getting coronavirus in routine interactions in daily life.

…[T]he best way for people to protect themselves and others is stay home and out of public places, making quarantine an important strategy to limit exposure. Is our best advice to pregnant/laboring people to travel out into the public, to a hospital full of those very people they need to stay away from? With medical facilities full of the sick and those caring for the sick, the benefits of staying home for physiologic childbirth and successful lactation become even more obvious.(emphasis in original)

Can you get coronavirus in a hospital? Healthcare workers have gotten it that way, but they spend their days dealing with the secretions of the very ill. As of yet, there have been no reports of individuals contracting coronavirus by visiting the hospital for some other condition.

So there’s NO REASON to think that hospital birth would put women at greater risk of getting coronavirus than riding the subway to get there. No matter, it’s a marketing bonanza.

What’s going on here?

Homebirth midwives adore homebirth. Very few women feel the same way.

Except in the Netherlands, homebirth is (and has been for decades) a fringe practice. Anything that engages 2% of the population or less is almost by definition a fringe practice. But maybe a deadly disease could spark increased interest!

Midwives are obsessed with homebirth for a number of reasons:

1. It is the natural end point of their obsession with promoting what they can do and demonizing what they cannot. They’ve gone from favoring the employment of midwives in maternity units, to midwife led units and birth centers. Homebirth is the logical next step, freeing them from any scrutiny by other health professionals.

2. It reflects the intellectually and moral bankrupt philosophy that the “best” birth is NOT the safest birth, but the birth with the least interventions.

3. It ensures that women cannot get effective pain relief.

4. It is a midwife full-employment plan. In contrast to a hospital based unit where one midwife can care for multiple women at a time, homebirth (in many countries) requires two midwives to care for one woman.

Lest you think that it is only American homebirth midwives who view coronavirus as a marketing opportunity, consider this tweet from British physician and homebirth advocate Susan Bewley who decorates her Twitter profile with her conceit that she is “speaking truth to power.”

Bewley is commenting on a Guardian article about midwives’ refusal to honor patient requests for epidurals.

07C9F87E-D651-4B94-8CC9-89DF5AD1E05C

I’m waiting for someone to write an article on the implications of coronovirus for birth & rediscover the place of birth recommendations…

Midwife Leah Hazard responds:

It would be so amazing if the pandemic encouraged more women to birth safely at home…

Amazing?

No doubt corona virus is a marketing bonanza for coffin makers, too, but at least they have the good sense to keep quiet about hoping to profit from deadly disease.

  • Mila Bacchini

    Pretty sure this article’s point of view is 100% correct for the US, except the Italian outbreak did definitely take its momentum in one emergency room.
    I don’t live in the hottest area, but every hospital in my city has had at least one unrelated, nonemergency ward quarantined because of Coronavirus cases, so anything medical that’s not absolutely urgent is now posponed.

    Being pregnant in the middle of an epidemic, with nationwide restrictions on movement of people, is scary enough that even a longtime skeptical OB reader like me had to fleetingly consider homebirth for logistical reasons, since the current restrictions would mean me going to the hospital alone – husband has to stay home and take care of our 3 years old and no one else is allowed to travel to come help me.

    • Who?

      Hope you are all safe and well over the next little while.

    • MaineJen

      Yikes! Could the hospital transport you in an emergency? Or maybe a police car…

      • Mila Bacchini

        Of course I can call an ambulance in a real emergency. Merely being in active labor would not qualify, and anything less than life or death is now very irresponsible since here ambulances are public, free and very much busy right now, with long downtimes between each patient because of extra careful disinfection procedures.
        Public transport will do in most situations.
        Additionally, now the procedures are really strict, so you can only have ONE designated person with you in the delivery room and that person is the only one that can stay overnight the first night if you have a C-section, visit you and baby in hospital and help you going home at discharge.
        We don’t have relatives in town, travel is not permitted for anything not strictly necessary, so I can only rely on the (fabulous) hospital midwives for help in the delivery room and pack a baby wrap in case none of my friends can drop my pram at the hospital for me on discharge day. If this was my first baby I’d be positively freaking out!

  • no longer drinking the koolaid

    Evidently none of these people are aware of maternity unit licensing regulations which dictate how OB units are almost a separate entity within the hospital. Your risk of contracting COVID 19 from maternity staff is probably smaller than the risk of contracting it from a community midwife.

  • mabelcruet

    OT, but this is starting to cause a bit of a stir.

    https://www.rcm.org.uk/promoting/learning-careers/accredited-learning/conscious-perinatal-resilience-method/

    The Royal College of Midwives is promoting training courses in perinatal psychology in order for midwives to act as perinatal psychology counsellors, via a fast track ‘intensive’ 3 day course. We have a huge shortage of proper perinatal psychologists and psychiatrists in the UK, and very few inpatient facilities for women who develop post-partum psychosis, so it is an issue, but doing it on the cheap by practitioners who have a very superficial understanding of mental health issues is absolutely not the way to go. I did 4 months in general psychiatry as a medical student, and a lot of on-the-job psychiatry during general practice/family doctor undergrad training (we did 6 months in GP in total over the years and psychiatric conditions are a huge part of the workload). Even so, I would be very wary of offering mental health advice to anyone beyond ‘maybe you should see a counsellor’ because it is so far out of my area of expertise that I would feel dangerously unsafe.

    Mental health is a vastly underrated speciality-its not a matter of patting someone on the hand and saying ‘there there, it’ll get better.’ People will die if they get this wrong, if they fail to pick up those women who are at risk of psychosis or suicide. The region where I work, I’m already concerned that midwives try and hold onto their patients (sorry, clients)-they really don’t like transferring them over to obstetric care as that seems to be seen as a ‘failure’. That’s partly what underlies the whole issue of women not getting epidurals despite requesting it-getting an epidural is somehow seen as a midwife failure because it means a doctor has to get involved. So with this mindset, I genuinely would be concerned that a perinatal resilience method practitioner would try and withhold referral to a properly qualified perinatal pyschologist or perinatal psychiatrist because they think they are qualified to deal with it. We don’t have enough midwives either, so taking midwives off the labour wards to provide mental health care is simply ridiculous. Mental health appointments done properly and thoroughly take time-the standard appointment is 1 hour, and followed up by very frequent reviews. It’s not something that can be tossed off in 5 minutes, or be undertaken by doing a questionnaire-it needs a lot of input and a lot of time. It can’t be done on the cheap or on the run, but I worry that this sort of course is implying that it can.

    • StephanieJR

      Three days?! I’m pretty sure you need at least three years, probably more, to be anywhere near properly qualified. I wouldn’t trust anyone with power over me who only did three days in anything.

      • mabelcruet

        This is going to make me sound old-fashioned and probably elitist, but I’m afraid it’s in line with other changes in NHS health care provision. Medical led health care is expensive, so there is a huge push because of the austerity drive to provide alternatives-we have paramedics now doing general practice, nurse practitioners doing clinics, people are advised to phone a helpline that takes them through an algorithm to decide whether they need a nurse, doctor, pharmacist or hospital, we’ve got physician assistants, pharmacists doing minor injuries and clinics.

        There have been specialist nurse practitioners around for a while, and in the right setting these are invaluable-they work semi-autonomously in certain areas such as asthma, patients on warfarin, epilepsy and diabetes. But this is for patients who have been medically reviewed, assessed and diagnosed and subsequently followed up. I don’t think a paramedic can replace a GP, not in the long term. Paramedics and GPs have very different skill sets, despite working in clinical care. Paramedics don’t have the training to deal with long standing chronic disease management, which is what a lot of GP care involves.

        I’ve seen it personally in the lab. We work with biomedical scientists (BMS) who do much of the technical aspect of pathology, dealing with tissue processing and preparation for pathological assessment. Its a degree level course, a general broad based science degree. There has been a move in the last few years to develop the role of BMS to train them to take up some of the work medical pathologists do. I actually supported this initially, I was the workplace supervisor of one of our senior BMS doing her dissection exam-the aim is to have BMS staff dissecting the surgical specimens coming into the lab, which frees up some medical pathologist time to look at more slides. We work side by side, but simply working alongside a different discipline doesn’t mean you can do the other’s work, but its typical of the way the NHS operates that a BMS is allowed to cover medical level work, but I wouldn’t be allowed to cover BMS work without completing a BMS degree (I know I sound bitter, but it really pisses me off that other people think they can do my job without going through the training I went through. I’ve heard the same from GP friends getting annoyed about the same thing).

        But anyway, I was workplace supervisor-she had been a BMS 20 years, was an intelligent and hard working individual but it was excruciatingly slow going. Without the clinical background, there was little understanding of what the specimen represents and what questions the clinicians are looking to answer, but that guides what bits of the tissue you need to examine and process for microscopy. Some specimens can be done very routinely, by protocol (simple stuff like appendix, gallbladder, skin biopsies) but sometimes the surgeon has had to modify his approach and the specimen sent is odd. A medical trained pathologist has the background to deal with this and re-think and re-orientate based on first principles, but without that background, people struggle. We had one case that illustrated it perfectly-we got a ‘POC’ (products of conception, early 1st trimester miscarriage). This is something the BMS had handled before multiple times and was perfectly capable of doing-they are usually a mix of placental tissue, slightly firmer decidua and blood clot. Unfortunately, the surgeon had filled the form in incorrectly, and it was an ectopic pregnancy comprising a fallopian tube. Now this BMS had dealt with ruptured ectopics too, so she knew how to dissect that. But because she was expecting a POC, she described it in terms of a POC, describing the fallopian tube as a sausage shaped mass of firm decidua. A medical trainee would have realised it was a tube and understood that the surgeon had written the wrong thing, but there isn’t that flexibility of thought and assessment without a medical background. Unfortunately, BMS dissection training is being rolled out because it is far cheaper than medical led dissection. Plus the BMS staff tend to stay put in one department, whilst trainees generally rotate through several, meaning that new batches of trainees keep arriving and keep needing to be trained. Some consultants prefer BMS dissection because it means that the consultants don’t have to keep training up new people but its doing a huge disservice to our trainees and future consultants.

        However, the government supports all of this-its far cheaper than employing more doctors. 90% of the time it’ll work out fine-a lot of my work is actually quite routine and I probably didn’t need all that training to do it. What I’m actually paid for is picking out the 10% of cases that are complex, it’s the same in most specialities. Most anaesthetics are routine, many GP consultations are simple sore throats or sore ears, so most of the time you can get away with it and patients won’t be at risk. But its that small percentage where things have the potential to go horribly wrong.

        • Ozlsn

          Also wanted to say that the difference in the way you are trained to think as a clinician and as a scientist or medical scientist is huge. I worked in clinical translation, which meant a lot of talking to people on both sides of the fence, and I quickly realised that for two groups of very intelligent people there was often a real communication gap because they couldn’t get how the other person had reached that conclusion. I absolutely love clinician scientists because they can translate, which made life so much easier!

    • rational thinker

      I think suicide rates will go up if they do this among other things.

  • Anna

    “ooh I’m so excited to see what happens if the demand for homebirths goes up and there aren’t enough services!!!!”. Well one of three things most likely – you take their money and miss their birth anyway or you take their money and bungle the birth or the woman gets lucky and has a smooth birth despite your bungling.

  • demodocus

    More of that people die in hospitals thing. Yes, of course they do. Because very ill and very injured people go there. Its like how more people are likely to get a burn from fireworks on the 4th of July here in the states.

  • Sarah

    A midwife can care for multiple actively labouring women? The mandated ratio here is a minimum of 2 midwives: 3 actively labouring women but 1:1 is considered best practice. Ante/postnatal is different, of course.

  • rational thinker

    Sure why risk giving birth in a hospital in the US where you have 0.01% of your newborn actually catching corona virus when you can give birth at home assisted by an incompetent fool and have a much higher chance of killing your baby in numerous ways, possibly yourself too!

    • demodocus

      Not to mention that so far there’ve been surprisingly few young child deaths. Mostly it’s older folks who’ve died. Flu is far more likely, and that’s everywhere

  • rational thinker

    These assholes have no shame.

  • Russell Jones

    OT but related, and speaking of scumbuckets, televangelist Jim Bakker (yes, he’s still around) is peddling something called “Silver Solution” that he claims will drive COVID-19 out of the human body within 12 hours. This is something along the lines of MMS, a bleach that Jim Humble (who claims to be a billion-year-old god from the Andromeda galaxy) hawks as a cure for everything from autism to cancer.

    The Attorney General of New York has already told Bakker to knock it off.

    If you’re looking for a reason to reject Christianity, look no further than the fact that Jim Bakker is still alive and grifting, whereas Tammy Faye died of cancer back in 2007.

    • mabelcruet

      We don’t really do TV evangelists in the UK. I think the nearest we have is Cliff Richard. Its probably to do with the English psyche of being embarrassed to show enthusiasm. It’s the same with politics-a politician trying to emulate the big political rallies in the USA would end up in a church hall with 25 people and an old man walking the dog in the UK.